Dear Sen. Rubio: Don’t gut the nation’s health care

The St. Augustine Record  Posted July 2, 2017 12:02 am

---

GUEST COLUMN: Dear Sen. Rubio: Don’t gut the nation’s health care

Jennifer Cowart

Jacksonville

 

I am writing this letter is in response to statements made by Sen. Marco Rubio regarding the Senate’s discussion of the American Health Care Act (AHCA). This is a bill that was rightly called “mean” by President Trump. As a hospitalist physician in Jacksonville, I’d like to set the record straight.
Individual exchange markets are destabilizing right now due to uncertainty regarding Trump’s threats to withhold the ACA’s cost-sharing reduction (CSR) payments. House Rep. Kevin Brady has called to fund these payments to stabilize the markets. Sen. Rubio should stand up to stabilize these markets by following the law and making the CSR payments.

Rubio stated he wants “managed Medicaid,” but the House bill and Trump’s budget do nothing to support Medicaid health management. Instead, they cut $800 billion out of Medicaid. These cuts go beyond removing the Medicaid expansion, representing a dramatic restructuring of the program. Though Florida will not lose out on Medicaid expansion, we will still lose coverage under the per-capita-cap scheme.
One estimate shows 378,000 people in Florida losing Medicaid coverage by 2028. Of those, 227,100 are children, 36,400 are people with disabilities and 51,200 are elderly who need long-term care services. Rubio should stand up for Floridians who receive health insurance through Medicaid.
Senator Rubio said Florida has state mandates that “go beyond” the 10 “essential health benefits” in the Affordable Care Act (ACA). A Medicare (CMS) report shows that, prior to the ACA, there was no requirement in Florida for individual plans to cover mental health, or for individual or small group plans to cover substance abuse. In 2015, 3,900 Floridians died of opioid overdose, causing Gov. Rick Scott to declare a state of emergency.
Rubio should not take Florida back to a time when substance abuse treatment was not required insurance coverage by repealing the ACA’s essential health benefits.
While Rubio represents Florida, the U.S. Senate makes decisions for all 50 states. For example, Alabama had no law prior to ACA requiring maternity coverage. Florida only required autism services to be covered by large-group plans.
While individual states may be better suited to decide how to regulate health insurance than the federal government, the federal system should appropriately set a minimum standard of protection across all 50 states. Rubio should not let our neighbors in Alabama lose protections like maternity coverage by repealing the ACA’s essential health benefits.
n Rubio said we weren’t talking about employer-based coverage, which is about 50 percent of the market. But the AHCA removes the employer mandate, which allows employers to choose not to offer health insurance to employees.
An estimated 150,500 Floridians will lose employer-sponsored health insurance under this plan. Rubio should stand for strengthening employer-sponsored insurance.
Rubio says he wants “big robust tax credits,” but the AHCA increases premium costs and lowers tax credits/subsidies for elderly sick patients. In some cases, this could increase premiums up to 800 percent.
The current bill is estimated to knock 700,900 Floridians off individual-market health insurance within 10 years. Rubio should stand up for those patients who are too young for Medicare, who have pre-existing conditions and who would be priced out of the individual market under the Upton-MacArthur amendment to the House bill.
Rubio says he wants to lower premiums. He says he wants to improve health management under Medicaid. He wants people in Florida to have certain benefits, which are mandated by Florida law.
To do that, he should stop treating this health care bill as a vehicle to cut taxes for the wealthy. Fix the ACA — don’t gut it. Reform Medicaid — don’t cap it. Protect pre-existing conditions and essential health benefits — don’t waiver them.
Allowing some states to gut pre-existing conditions hurts us all. America needs a healthy population in order to have a healthy economy. As a physician, I take care of sick people in Jacksonville every day. I expect my local, state, and federal elected representatives to do the same, including Sen. Rubio.